蒙古社区卫生保健工作者对多药耐药结核病家庭接触者进行查和管理:一项前性实施研究
Bazarragchaa Tsogt1, Tsegmed Sambuu2, Yanjindulam Purevsuren3
1Mongolian Anti-Tuberculosis Coalition, Ulaanbaatar, Mongolia.
The Lancet regional health. Western Pacific
|October 23, 2025
概括
在蒙古,以社区为基础的方法成功选了家庭接触者多药耐药结核病 (MDR/RR-TB). 这一战略提高了结核病的检测和预防,显示了更广泛的区域应用的潜力.
科学领域:
- 公共卫生 公共卫生
- 传染病流行病学 传染病流行病学
- 全球健康 全球健康
背景情况:
- 蒙古面临着多种药物或利芬辛耐药结核病 (MDR/RR-TB) 的高负担.
- 对结核病的系统家庭接触调查的实施是有限的.
- 针对MDR/RR-TB接触者查和管理,实施了基于社区的方法.
研究的目的:
- 评估一种基于社区的方法,用于查和管理蒙古的MDR/RR-TB患者的家庭接触者.
- 评估使用社区卫生工作者 (CHW) 进行结核病接触者追踪的可行性和有效性.
主要方法:
- 在乌兰巴托和10个省份进行了前性实施研究.
- 社区卫生工作者 (CHWs) 接受了培训,以查已确认的肺部MDR/RR-TB患者的家庭接触者.
- 查包括症状评估,成年人的胸部放射,以及15岁以下的人的结核素皮肤测试 (TST). 进行了为期12个月的季度后续访问. 符合条件的接触者 (<15岁,TST阳性,没有疾病) 提供六个月的勒沃素 (6Lfx).
主要成果:
- 在99名指数患者中,349个家庭接触者中有347人 (99.4%) 接受了查.
- 在17名接触者 (4.9%) 中诊断出结核病,12人是儿童或青少年.
- 四名接触者有细菌学确认的MDR/RR-TB,两人死亡. 15名符合条件的接触者完成了6Lfx治疗.
结论:
- 使用训练有素的医疗保健医生进行MDR/RR-TB接触查和管理的分散型模型是可行的.
- 这种方法具有显著的潜力,可以改善蒙古和更广泛地区的结核病检测和预防.
- 基于社区的战略对于解决结核病接触调查缺口至关重要.
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